Provider Demographics
NPI:1306923594
Name:GARRETT, WILLIAM F JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 TRAILMORE PL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2711
Mailing Address - Country:US
Mailing Address - Phone:404-543-9516
Mailing Address - Fax:
Practice Address - Street 1:4684 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3074
Practice Address - Country:US
Practice Address - Phone:404-843-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049942208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30848Medicare UPIN
93BBJSQMedicare ID - Type Unspecified